Basic Information
Provider Information
NPI: 1003141292
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOOPER
FirstName: DAVID
MiddleName: ANDREW
NamePrefix:  
NameSuffix:  
Credential: AA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 918025
Address2:  
City: ORLANDO
State: FL
PostalCode: 328918025
CountryCode: US
TelephoneNumber: 3522736575
FaxNumber: 3523927029
Practice Location
Address1: 1600 SW ARCHER RD
Address2:  
City: GAINESVILLE
State: FL
PostalCode: 326103003
CountryCode: US
TelephoneNumber: 3522736575
FaxNumber: 3523927029
Other Information
ProviderEnumerationDate: 10/06/2009
LastUpdateDate: 10/05/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367H00000XAA54FLY Physician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant 
367H00000X005637GAN Physician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant 

No ID Information.


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